title: [Diagnosis of allergic and non-allergic hypersensitivity reactions to commonly used drugs and biological substances in children: diagnostic algorithm].
abstract: Suspected allergic reactions to drugs and biological substances (anti-infectious drugs and antipyretics, non opioid analgesics and nonsteroidal anti-inflammatory drugs especially) are reported in 5 to 12% of children. Most frequent reactions are morbilliform/maculopapular rashes, urticaria and angioedema. Other cutaneous and respiratory reactions, and severe allergic and non-allergic anaphylactic reactions are rare. The results of studies based on allergological tests and/or microbiological/serological tests strongly suggest that, except for a few types of reactions (anaphylactic and/or immediate reactions, potentially harmful toxidermias) and for very specific drugs (i.e. latex and myorelaxants), most reactions to commonly used drugs and biological substances in children do not result from drug hypersensitivity, but are rather a consequence of the infectious and/or inflammatory diseases for which the drugs have been prescribed. Non-immediate reactions may also result from complex interactions between drugs, immune system and "danger signals" provided or induced by infectious and/or inflammatory diseases. Diagnosis is based above all on a detailed analysis of clinical history, skin tests (if validated), and challenge tests (if indicated). At present, the diagnostic and predictive values of in vitro tests exploring immediate (specific IgE determination, histamine and leukotriene release tests, basophil activation test) and non-immediate type (lymphocyte activation tests, and cytokine assays in the supernatant of activated blood mononuclear cells) of drug hypersensitivity are not validated.
authors.affiliation: Service de pneumologie et allergologie, département de pédiatrie, hôpital Necker-Enfants-Malades, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France. claude.ponvert@nck.aphp.fr
authors.forename: C
authors.initials: C
authors.lastname: Ponvert
mesh_terms: D000465:Algorithms; D002648:Child; D004342:Drug Hypersensitivity / Q000175:diagnosis*; D006801:Humans